阿戈美拉汀治疗单一复发性非精神病性抑郁症的经验

L. A. Ivanova, A. Kovaleva, N. O. Sitnikova
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A single DE was diagnosed in 62.2% of patients, and recurrent depressive disorder in 37.8%. Stress-related onset of current DE was found in 56.8% of cases, autochthonous in 43.2%.Results. 94.6% of patients were responders, including 68.6% who went into remission. A statistically significant decrease in scores on the HAMD-17 scale was noted in the remission group from the 7th day of agomelatine therapy (p<0.05), in the responder group – from the 14th day of therapy (p<0.05). According to the Sheehan scale, a statistically significant decrease in scores was noted at the end of the first week of therapy (p<0.05), according to the Spielberger–Khanin scale – in the second week (p<0.05) in all patients. According to the CGI-I scale, the condition at the end of therapy improved in 57.1% of patients, significantly in 42.9%. 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引用次数: 0

摘要

抑郁症的治疗是当前精神病学的一个问题。阿戈美拉汀在抗抑郁疗效(反应率和缓解率)方面不逊于其他现代药物,并具有最佳耐受性。目的:评价阿戈美拉汀治疗单次复发性非精神病性抑郁症的疗效和安全性。材料和方法。患者(n=37)当前有抑郁发作(DE;F32例(按ICD-10评分),平均年龄41.2±2.07岁。本研究采用临床精神病理学和心理测量学方法(汉密尔顿医院抑郁量表- HAMD-17;斯皮尔伯格-哈宁焦虑自评量表、希恩焦虑量表、临床整体印象量表(CGI-I)。62.2%的患者被诊断为单一DE, 37.8%的患者被诊断为复发性抑郁症。应激相关的DE发生率为56.8%,原生DE发生率为43.2%。94.6%的患者有反应,其中68.6%进入缓解期。从阿戈美拉汀治疗的第7天开始,缓解组HAMD-17评分有统计学意义的下降(p<0.05),在反应组-从治疗的第14天开始(p<0.05)。根据Sheehan量表,在治疗第一周结束时,所有患者的得分均有统计学意义的下降(p<0.05),根据Spielberger-Khanin量表,在治疗第二周结束时,所有患者的得分均有统计学意义的下降(p<0.05)。根据CGI-I量表,治疗结束时病情改善的患者占57.1%,显著改善的患者占42.9%。缓解期患者治疗反应的临床预测因子包括:单次DE发生率显著升高(p<0.02)、当前抑郁中度严重程度(p<0.02)、自主神经障碍中的头晕(p<0.01)、忧郁型抑郁的发生率显著降低(p<0.05)、对未来悲观悲观的症状(p<0.05)、睡眠障碍(p<0.04)、抑郁型抑郁的发生率显著降低(p<0.05)。在当前DE的应激性发作患者中,以威胁形式存在的个人重要因素(p<0.05)。14.3%的病例在阿戈美拉汀治疗的第一周发生不良事件(恶心- 8.6%,头痛和头晕- 2.9%),它们是轻微的,不需要停药。两名服用阿戈美拉汀50毫克剂量的患者停止了研究:其中一名患者持续存在社交恐惧症,增加疲劳,运动迟缓和持续的现代失眠症;另1例为明显的老年痛综合征伴脑定位。阿戈美拉汀治疗已被证明对非精神病性抑郁症非常有效且耐受性良好。
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Experience with agomelatine therapy for non-psychotic depression with a single and recurrent course
Therapy of depression is a current problem in psychiatry. Agomelatine is not inferior to other modern drugs in terms of antidepressant efficacy (response and remission rates) and is characterized by the best tolerability.Objective: to evaluate the efficacy and safety of agomelatine in the treatment of nonpsychotic depression with a single and recurrent course.Material and methods. Patients (n=37) with a current depressive episode (DE; F32 according to ICD-10), mean age 41.2±2.07 years, were studied. Clinical psychopathological and psychometric methods were used in the study (Hamilton Hospital Depression Scale – HAMD-17; Spielberger–Khanin Anxiety Self-Assessment Scale, Sheehan Anxiety Scale, Clinical Global Impression Scale – CGI-I). A single DE was diagnosed in 62.2% of patients, and recurrent depressive disorder in 37.8%. Stress-related onset of current DE was found in 56.8% of cases, autochthonous in 43.2%.Results. 94.6% of patients were responders, including 68.6% who went into remission. A statistically significant decrease in scores on the HAMD-17 scale was noted in the remission group from the 7th day of agomelatine therapy (p<0.05), in the responder group – from the 14th day of therapy (p<0.05). According to the Sheehan scale, a statistically significant decrease in scores was noted at the end of the first week of therapy (p<0.05), according to the Spielberger–Khanin scale – in the second week (p<0.05) in all patients. According to the CGI-I scale, the condition at the end of therapy improved in 57.1% of patients, significantly in 42.9%. Clinical predictors of therapeutic response in patients with remission included significantly higher frequency of a single DE (p<0.02), moderate severity of current depression (p<0.02), dizziness among autonomic disorders (p<0.01), a significantly lower representation of the melancholic type of depression (p<0.05), a symptom of a gloomy and pessimistic vision of the future (p<0.05), sleep disturbances (p<0.04), a factor of personal significance in the form of a threat in patients with stress-provoked onset of the current DE (p<0.05).Adverse events occurred in the first week of treatment with agomelatine in 14.3% of cases (nausea – 8.6%, headache and dizziness – 2.9% each), they were mild and did not require discontinuation of the drug. Two patients taking agomelatine at a dose of 50 mg discontinued the study: in one case persisted social phobia, increased fatigue, motor retardation, and persistent modern insomnia; in the other case – a pronounced senestoalgic syndrome with cerebral localization.Conclusion. Agomelatine therapy has been shown to be highly effective and well tolerated in nonpsychotic depression.
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